Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, 7070 Champlain Blvd, Verdun, QC H4H 1A8, Canada.
Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, 7070 Champlain Blvd, Verdun, QC H4H 1A8, Canada; Department of Psychiatry, Ludmer Research & Training Building, McGill University, 1033 Pine Avenue West, Montreal, QC H3A 1A1, Canada.
Int J Nurs Stud. 2020 Aug;108:103583. doi: 10.1016/j.ijnurstu.2020.103583. Epub 2020 Apr 29.
Specialized early intervention programs for individuals experiencing a first episode of psychosis prioritize service engagement, generally operationalized as attendance, treatment completion, therapeutic alliance, and treatment adherence. However, there are critical theoretical and methodological gaps in understanding how service users experience and define their engagement with the service.
This study aimed to explore how current and former service users define their engagement with a specialized early intervention program.
A qualitative descriptive approach was used to explore service users' decisions to use, remain involved with, and/or leave early intervention services.
This study took place in an early intervention service for psychosis in Montreal, Canada.
Twenty-four participants who had experienced a first episode of psychosis and had been engaged in the service to varying degrees (fully engaged, partially engaged, disengaged) took part in in-depth interviews.
In-depth interviews were employed to collect rich insights into participants' experiences and perceptions. The interviews were transcribed and analysed using thematic analysis, beginning with an inductive approach and completing the analysis using a theoretical approach. During the analysis, our original notions of engagement and disengagement were challenged by theorizing engagement in terms of agency and structure. Researchers engaged in reflexive practices to maintain and promote research rigor and trustworthiness.
Participants' narratives were thematically analyzed and organized into three themes: fluidity and temporality of engagement and disengagement; engagement as an ongoing negotiation; and critical structures and agency. Participants described engagement in a variety of ways, some of which were broader than service use and focused on self-care and commitment to recovery. These conceptions were subject to change as the individuals' perceptions of their needs changed. As needs changed, individuals also negotiated and renegotiated their care needs with themselves and with their treatment team. These exercises of agency were constrained by key structures: the treatment team, family and friends, and societal conceptions of mental health.
Our study findings argue for an expanded definition of engagement which prioritizes individuals' experience and acknowledges the steps towards recovery that they may make outside of the purview of the service. It also underlines the importance of a treatment structure which aligns with individuals' needs for both support and autonomy.
专门针对首次出现精神病症状的个体的早期干预计划优先考虑服务的参与度，通常表现为出勤率、治疗完成率、治疗联盟和治疗依从性。然而，在理解服务使用者如何体验和定义他们与服务的参与度方面，仍存在着重要的理论和方法上的差距。
本研究旨在探讨当前和以前的服务使用者如何定义他们与专门的早期干预计划的参与度。
采用定性描述方法来探索服务使用者使用、继续参与和/或离开早期干预服务的决策。
本研究在加拿大蒙特利尔的一个早期干预精神病服务机构进行。
24 名参与者经历了首次精神病发作，并在不同程度上参与了该服务（完全参与、部分参与、不参与），他们参加了深入访谈。
采用深入访谈的方法，从参与者的经验和感知中收集丰富的见解。访谈内容被转录，并使用主题分析进行分析，首先采用归纳法，然后使用理论方法完成分析。在分析过程中，我们对参与和脱离的最初概念提出了挑战，将参与理解为代理和结构的问题。研究人员进行了反思实践，以保持和促进研究的严谨性和可信度。
对参与者的叙述进行了主题分析，并组织成三个主题：参与和脱离的流动性和暂时性；参与是一个持续的协商过程；关键结构和代理。参与者以各种方式描述了参与，其中一些比服务使用更广泛，侧重于自我护理和对康复的承诺。随着个人对自身需求的看法发生变化，这些观念也会发生变化。随着需求的变化，个人也与自己和治疗团队协商和重新协商他们的护理需求。这些代理的行使受到关键结构的限制：治疗团队、家庭和朋友以及社会对心理健康的观念。
我们的研究结果认为，需要扩大参与度的定义，优先考虑个人的体验，并承认他们在服务范围之外迈向康复的步骤。它还强调了治疗结构的重要性，该结构既要满足个人对支持和自主权的需求。
